According to a recent report, global warming has surpassed the limits of human survival, posing a significant threat to our well-being and existence. Rising temperatures are causing immediate health impacts and increasing the risk of non-communicable diseases (NCDs) in the long term. Despite the situation’s urgency, we must adequately address these issues in the upcoming 28th United Nations climate conference (COP28) agenda.

The tangible impacts of this changing climate — heatwaves, raging wildfires, and soaring temperatures — are now daily headlines. Yet, the mounting toll on human health and, by extension, the global economy is alarmingly underreported. From acute afflictions like heatstroke to chronic conditions such as kidney disease, the health bill of our warming planet is escalating. UN Secretary-General Antonio Guterres’s recent remarks that we’ve transitioned from “global warming” to “global boiling” should jolt the financial community into recognising the profound economic implications ahead.

Yet, amidst this surge in health threats, a crucial aspect remains largely sidelined: non-communicable diseases (NCDs) exacerbated by extreme heat. Predictive models warn of surging mortality rates from heat-related NCDs by 2030, predominantly in economically significant regions like Asia, Europe, and North America. It’s not just a health crisis; it’s an impending economic one, with substantial disruptions to workforces and healthcare systems.

The ‘wet bulb temperature’ is critical to understanding this risk, an indicator of temperature combined with humidity. Human survival becomes compromised when this metric breaches specific thresholds, jeopardising productivity and economic stability. If current trends hold, we risk pushing vast swathes of the global populace out of habitable zones. According to the latest Intergovernmental Panel on Climate Change (IPCC) report, the world could see over nine million climate-related deaths annually by the end of the century.

Alarmingly, even as the Paris Agreement set forth ambitious targets, we find ourselves already breaching set thresholds. Warnings from the likes of the World Meteorological Organization underscore our precarious path, with threats not just to human health but to food security, water resources, and ecosystems — the very foundations of many global economies.

Furthermore, let’s consider the workforce, particularly outdoor workers in sectors like agriculture and construction. They are now emerging as the frontline victims of our changing climate. Inadequate protective measures in many countries, and some cases, regressive policy changes, threaten not just individual health but sectoral productivity and economic contributions. The ramifications for global supply chains, commodity prices, and overall financial stability cannot be overstated.

Beyond the direct heat impacts, the broader effects of climate change on food supplies present a pressing concern for global markets. As crops fail, livestock suffer, and fisheries decline, we’re confronted with potential volatility in food prices and security, with cascading implications for economies worldwide.

Global warming has surpassed the limits of human survival, resulting in severe health consequences and an increased risk of NCDs. Failing to prioritise prevention strategies and support effective climate action during the upcoming COP28 negotiations puts the global population at further risk. We must take urgent measures to address the health impacts of climate change, mitigate global warming, and support the adaptation of vulnerable communities. We hope to secure a sustainable future for humankind through collective efforts.

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America’s changing diet and physical fitness

How we eat looks a lot different today compared to 40 years ago in terms of how much and what we consume. The Pew Research Center analyzed data from the U.S. Department of Agriculture (USDA) and found that in 2010, Americans ate around 23% more calories than in 1970. That adds up to about 2,481 calories a day, more than the suggested 1,850 to 2,000 calories adults need to maintain their current weight. The Pew report also shows that we are eating less meat, dairy, sweeteners, fruits, and vegetables today than in 1970.

Along with diet, exercise has also changed over the years. The field of exercise science began in the 1800s to better the health of working-class people using dance and sports. By the end of World War II, more Americans worked in factories, resulting in less strenuous activity than farm work. The sedentary lifestyle culminated in the invention of the television, which kept more people at home and less active.

In the 1950s, a global study revealed that American children were less fit than their counterparts in other countries. The study prompted the establishment of the President’s Council on Youth Fitness. The council began to take shape under the John F. Kennedy administration, launching a national campaign on physical fitness and physical education curriculum for schools across the country. The council and its programs are credited with changing public attitudes and improving fitness nationwide.

Does exercise work for weight loss?

You may wonder how exercise fits into a weight loss program. Unfortunately, you probably will not see significant weight loss from exercise alone. Many people overestimate the number of calories they burn by exercising, which can lead to misjudging the number of calories they can consume. Exercise may also trigger hunger or the idea that you can splurge calories on a treat because you went to the gym. Research shows that changes to your diet – eating fewer calories and more nutrient-dense food – are a better strategy for long-term weight loss.

While it may not help you lose weight, exercise still offers many potential health benefits, like better sleep, lower anxiety, and weight maintenance. In recent years, Marissa Quinones of Grand Prairie, Texas, has prioritized exercise as part of her daily life. Quinones, the director of medical affairs strategy for a biopharmaceutical company, began participating in fitness challenges through Women of Color in Pharma (WOCIP), a network of more than 900 female professionals working in the pharmaceutical industry. Each season, WOCIP hosts the Nike Run Club, an 8-week challenge that encourages members to log at least 25 hours of walking, running, or jogging miles per month. The challenges have fostered a spirit of friendly competition in Quinones, and a love of walking, hiking, and the outdoors.

“I prefer to be out in nature. It helps to clear my mind and get ready for the day,” she says. Compared to indoor exercise, walking outdoors also helps her focus more on enjoying exercise and less on the time spent doing it. ”I’m not really good at the treadmill. It wasn’t fun for me.”

Quinones walked almost 250 miles in 2021; by September 2022, she had already surpassed that number, with the goal of reaching 300 miles by the end of the year. Beyond the physical benefits, she views walking and other exercise like yoga as self-care for her mental health. Science confirms this idea – an extensive study of 1.2 million people living in the U.S. published in The Lancet Psychiatry found a meaningful link between physical exercise and improved mental health, depending on the type, duration, and frequency of the exercise.

What are the different types of diets, and do they work?

Despite gains in physical activity, more Americans have become overweight or obese over nearly 50 years, which has led to the rise of a culture of dieting. An imbalance between the calories you consume and the number your body burns causes obesity. Losing 5% to 10% of your body weight can lower blood pressure, triglycerides, and blood sugar. Dieting for weight loss usually involves including more of a particular food or food group while excluding others. We use a wide variety of methods to shed pounds, from low-carb, high-protein diets, to fasting and cutting out all animal products. But which ones actually work to lose weight and keep it off? First, it may be helpful to look at the different types of diets. Most fit into one of three categories:

Controlling macronutrient content. This involves managing the nutrients you consume. For example, eating more protein and fewer carbohydrates on the Atkins diet. Or diets that require you to cut back on certain types of fat.

Restricting or eliminating certain foods. Vegan, paleo, gluten-free, and Mediterranean diets fall into this category. They all require you to stop eating specific foods or food groups.

Controlling the timing of when you eat. Many people use intermittent fasting as a way to lose or control weight. This is when you stop eating and drinking for a certain period. Common types of intermittent fasting include periodic fasting, alternate day fasting, time-restricted feeding, and religious fasting.

Scientists have examined whether these diets are effective for weight loss and maintenance. A 2019 study from a researcher at Harvard Medical School looked at several popular diets and eating methods. In the short-term, high-protein, low-carb diets and intermittent fasting could help “jump start” weight loss and boost the amount of weight you lose, according to the study. But researchers caution that these diets may come with side effects such as weakness and headaches.

Over an extended period, the type of diet you choose may not matter as much. Research shows that different diets resulted in similar amounts of weight loss. The bottom line is that no one way of eating works universally for weight loss. What matters most is the quality of your food, burning more calories than you consume, and sticking with a diet for the long term.

To lose weight and keep it off, experts recommend lifestyle changes such as eating fewer calories, more nutritious foods, and participating in physical activity. It may also require things like therapy, medication, or even weight loss surgery.

A note on BMI

It’s also important to note that although many doctors and scientists use body mass index (BMI) to measure whether a person is overweight or obese, it’s not a definitive test. It is a single measure in a larger picture of your overall health.

Plus, BMI definitions are based on white bodies. Race and ethnicity can determine the makeup of your body, including body fat percentage and amount of muscle mass. This means BMI may be a less accurate measure for some people of color. Your doctor should also look at other things like blood pressure, cholesterol, and blood sugar to get a more detailed view of your health.

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If current trends persist, nearly one in three Americans will develop type II diabetes alone in their lifetime. In addition to diabetes, the prevalence of other chronic lifestyle conditions such as obesity, heart disease, inflammatory bowel disease, chronic kidney disease and arthritis are growing exponentially. An equally daunting mental health crisis has emerged exacerbated by the Covid-19 pandemic. Significantly, neuropsychiatric disorders and inflammation have been closely intertwined, powering each other in a bidirectional loop. Thus, these two terrible epidemics may have compounding effects wreaking havoc on our societies.

Coupling this grim outlook with research findings showing that just 10 minutes of daily exercise will save an additional 110,000 lives each year in the US and just 30–60 minutes of strength training per week reduces all-cause mortality by 20%, you soon realize that a sick care system which relies mainly on medical interventions is grossly inadequate for improving health outcomes. And it runs counterintuitive to literature, and factors beyond medical interventions drive public health experts that suggest upwards of 70% of health outcomes are driven by factors beyond medical interventions.

With sick care spending having grown to nearly 20% of US GDP, we cannot afford to manage, let alone conventionally treat, chronic inflammatory conditions, the bulk of which remain preventable. At the same time, two-thirds of all personal bankruptcies in the US cite medical issues as the main reason.

Why have we found ourselves here? An oft-cited reason is that approximately 90% of the US health budget is spent via a fee-for-service reimbursement structure, which incentivizes volume and complexity of interventions. At the outset, this logic seems reasonable: one should only receive, and therefore pay for, an intervention if needed.

The problem, of course, is this system does not account for, nor incentivize approaches to prevent the disease from happening in the first place, thus preventing the need for these costly interventions. Given incentives drive decision making; it should come as no surprise that prevention has fallen short of becoming a viable business model, let alone one that can scale. But there is a recognizable paradox that has historically challenged preventative care: how can one distinguish the need for and, therefore, the outcomes and value of a preventive method?

The answer to resolving the prevention paradox is linking small behavioral changes to changes in personal health status (positive and negative) which can then be connected to economic value (creation and destruction). Such a capability has not existed to date. Yet, rapid developments of the internet of things, the cloud and AI/ML have given rise to the behaviorome (quantified characterization of behaviors) and environmentome (quantified characterization of social determinants of health), yielding nuanced insight into how daily decisions and behaviors in a given environment impact a person’s health.

As the behavioromes and environmentomes of a population become better characterized over time and linked to outcomes, a personal, dynamic health score could be calculated for individuals in that population. This dynamic health score could enable the prediction and assessment of a preventative intervention for an individual, potentially before the onset of detectable symptoms of chronic conditions, ultimately paving the way for a sustainable Prevention-as-a-Service (PaaS) business model. This new paradigm would aim to keep people healthy and dramatically alter the unsustainable course of the current healthcare model by bringing about significantly better outcomes at a lower cost.

The scalability of PaaS relies on modern data analytics methodologies such as machine learning that are well-suited for analysis, pattern recognition, and adaptive recommendations based on individual and population aggregate-level data. One can now begin to (a) create genuinely ‘personalized’ preventive programs and incentives that are more effective and (b) link small changes in an individual’s health status to value through a meaningful health score, which correlates with the value of prevention on an individualized basis.

If one can do this, then Prevention-as-a-Service becomes a sustainable business where there is an agreed-upon value creation standard through health score changes. Created value can then be shared between the person and all stakeholders dependent upon said individual staying healthy, such as healthcare paying entities. Moreover, this approach could employ behavioral economic models to support behavior change more effectively than today’s population-level best practices.

We believe that the infrastructure for PaaS is already here and that value creation through a dynamic health score will deliver, for the first time, a viable business model for prevention which is both scalable and sustainable. A platform dedicated to PaaS will empower citizens with health education and literacy, ensure inclusivity & health equity, and deliver convenience and community, all while leveraging behavioral economic models based on individualized health scores to incentivize each person’s health journey.

Preventing citizens from falling sick to lifelong chronic conditions may have sounded utopian in the past — it no longer is. Now is the time to do something about it.

It’s time to unleash health.

Credits: This article is a collaboration between Dr. Ramin Rafiei, CEO and Co-Founder of Reformulate Health and Dr. Jacob LaPorte, Co-Founder and Global Head of the Novartis Biome with equal contributions by both authors.

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Consider my great, great grandparents. They lived on a small farm and were largely self-sufficient. They ate two or three meals a day and never snacked. Food was locally sourced; vegetables and fruits were fresh and ripe; chickens spent the day in the fields. Fish came out of nearby streams and rivers, and meat came from animals hunted in the forests or grazed on the farm.

There were no pesticides, no foods shipped thousands of miles, no meat from animals fattened with corn and soybeans, no fish from fish farms. Candy, soda, and junk foods were almost unknown. There were no processed and packaged foods as we know them, and there were no fast-food restaurants — foods that are all heavily marketed today yet are inherently unhealthy but tasty with their ingredients of white flour, fat, sugar, and salt.

Everyone moved all day long, mostly outdoors; that was just natural. And much of that movement was hard work, the kind that kept muscles strong from lifting, bending, digging, or hoeing. The kids were sent out, if not helping with farm chores, to play, play that included lots of movement.

Of course, stress was present, but somehow, they dealt with it, allowing it to “run off their backs.” After a day of good food and plenty of movement, they slept easily and soundly from when the sun went down until the sun came up. Very few people smoked; cigarettes were not available. Alcohol was abundant, mostly homemade cider, beer, and wine, but most did not drink excessively.

Life was a constant challenge to the mind as well as the body. Families worked and played together and interacted with their neighbors. There were no radios, TVs, or video games; families interacted with each other, and grandparents were honored and part of the family.

Many people, of course, died early, especially of trauma, childbirth, and infectious diseases. Still, many also lived to a “ripe old age” yet rarely developed the chronic diseases of today — obesity, diabetes, lung cancer, stroke, Alzheimer’s, or heart disease.

We do not live like that today and there is no reason to try to go back. But is there anything you can do directly to avoid developing a chronic disease now or in the future? Yes. It is all about modifying your lifestyles.

There are seven key steps.

• Eat a healthy diet every day
• Get adequate exercise at least 6 days per week
• Manage your chronic stress
• Enhance your sleep
• Don’t smoke or overdrink alcohol; don’t get hooked on drugs
• Challenge your brain regularly
• Stay socially engaged.

Be sure to take good care of your teeth, don’t drink or text and drive. Develop a positive attitude and be sure you have thought about your purpose in life.

According to the Centers for Disease Control (CDC,) Americans consume an average of 57 pounds of added sugar annually! Packaged in 4-pound bags, imagine 14 bags on your kitchen table — four times that for a family of four. Of course, you are sure you don’t eat that much added sugar, but someone else is consuming even more to make it average out. To top it off, we eat an excessive number of foods made from white flour (e.g., cereal, cakes, pies, cookies, pastries, and pizza) — which is digested directly into sugar. And, of course, many of those foods are high in added sugar and often fats and salt.

Here is a bit more detail: For adult Americans, men consume about 19 teaspoons (76 grams) of sugar per day; women 15 (60 grams), both well above the recommendations of the American Heart Association of 9 teaspoons (38 grams) for men and 6 tsp (25 grams) for women. In addition, the World Health Organization recommends no more than 5% of a 2000-calorie diet be from added sugars (including honey, fruit juices, etc.) or 25 grams per day.

Lack of exercise and an unhealthy diet go together. Today we drive to work, stop for a pastry and latte, sit at a desk most of the day, eat a fast-food lunch, enjoy an afternoon snack, drive home, call out for pizza, watch television, and go to bed.

Stress is everywhere — you need to check your emails and texts right up to bedtime. Your stress levels are off the charts. You probably don’t smoke and that is good. You have all too little time for socializing with true friends. The alarm rings all too early, and you are up and at it again.

What can you do? Will it really make a difference? Yes, focus on these 7 keys of lifestyle modifications.

1-Prepare meals from scratch; it does not take much time. Think of it not as a diet that eliminates something but one that includes abundant nutrient-dense foods. Eat locally sourced, preferably organic vegetables and fruits in abundance.

Vegetables should be the major components of your diet with a wide variety of types, colors, and textures to obtain all of the primary nutrients. Include dark green leafies daily — spinach, collards, arugula, and kale are good choices. Nuts, seeds, and foods like avocados and olives have healthy oils, and omega-3 fatty acids are in wild-caught finfish like salmon, mackerel, and sardines. Avoid vegetable oils; use cold-pressed virgin olive oil instead.

Don’t forget to have plenty of fresh fruits every day.

Choose chickens and eggs from hens that have been free-ranged. Eat red meat sparingly and choose cuts from range-fed animals that never saw a feedlot. Finally, and very importantly, avoid sugars like the plague and dramatically reduce your intake of foods made from white flour. It follows that you will cut back on processed foods and meals from fast-food restaurants. The Mediterranean Diet is the prototype for this type of eating.

2-Get up and move. Get 30 minutes of walking every day. That alone will have a massive impact on your immediate and long-term health. Add in a few sessions per week of strengthening (“resistance”) exercises. Remember that “sitting is the new smoking.” Park your car a distance from the building entrance. Take the stairs a few flights instead of the elevator. Get up from your computer and move around for five minutes at least every half hour. Consider a stand-up desk. Spend less time sitting in a reclining chair watching TV at night.

3-We all have chronic stress, but many don’t recognize or admit it. Give some serious thought time to your pressures. Eliminate the causes where possible and, for the remainder, consider ways to tamp them down. In addition to good food and regular exercise along with adequate sleep, add in perhaps yoga, meditation, Tai Chi, coherent breathing, or just a few moments every so often to take a couple of deep breaths with the exhalation longer than the inhalation (I will explain the rationale for longer exhales in a later article.)

4-To enhance sleep, allot at least three hours between finishing dinner and bedtime so that your meal has been largely digested. This, of course, means no late-night snack before bed. No caffeine after noon. Avoid reading or watching action or horror books, TV shows, and movies before bedtime. Early in the evening, please turn off your smartphone and the texts, emails, and Facebook with it. Instead, consider some soothing music before bed. Your bedroom needs to be pitch black with all your devices turned off. Keep to a schedule, and remember that you need 7 ½ to eight hours of sleep each night. Please don’t listen to the friend that claims they can get by on 5 or 6 hours; that person is only fooling themself.

5-No tobacco. None, including vaping. And keep alcohol consumption limited.

6-Stimulate and challenge your brain. It needs to be used just like your muscles. Learn a new language or play an instrument. Learn a dance routine. Do something creative like art or writing.

7-Social engagement is critical to slow aging, prevent disease, and enhance a sense of wellness. Maintain connections with close friends and relatives.

Does all of this make a difference? Yes.

In the Nurse’s Health Study and the Health Professionals Follow-up Study totaling over 100,000 participants and observed for more than 30 years, those who followed the five “low-risk lifestyles” lived substantially longer than those who followed none. For example, a 50-year-old female could expect to live 14 added years (life expectancy rose from 29 to 43 additional years), and for a male, 12 additional years (26 rose to 38 additional years.) I will explore this and similar studies in-depth in a later article.

Whatever the exact number of added years, the direction is clear. Healthy lifestyles mean more years of healthy life. And remember, it was not just more years of life but fewer chronic illnesses for a longer “health span.” Definitely worthwhile.

Does this seem like a tall order? Perhaps, but pick one or two areas to work on at a time. Don’t try to do it all at once. Don’t set the goal too high to start. Set some intermediate goals, ones that you can achieve. Then move up to a more comprehensive goal. After a while, you’ll be doing great; you’ll have more energy, more enthusiasm for life, much better health, and a longer, healthier lifespan. And as a bonus, if you get started early in adult life, you will reap the added benefits of compounding, just like saving for retirement. What could be better than that?

The post What Can You Do To Prevent Developing a Chronic Disease? appeared first on Medika Life.

Investigators recently sought to determine if they could use a single question as a screening tool for nutrition studies. Currently, nutrition researchers commonly use detailed dietary questionnaires.

For the National Health and Nutrition Examination Survey, subjects completed detailed 24-hour dietary recall questionnaires. These study participants then rated their diets as excellent, good, fair, or poor.

Is your diet worse than you think?

What would be your answer if I asked you this simple question: How healthy is your diet? A recent online study suggests that we may not have great personal insight.

While historical research indicates that self-rated health strongly predicts morbidity and mortality, we do not know if self-rated diet quality products the actual quality of one’s diet.

The researchers used the food recall questionnaires to score each subject’s diet quality. Foods regarded to be less healthy included those with added sugars, saturated fats, or refined grains.

On the other hand, the researchers classified healthy foods like whole grains, fruits and vegetables, healthy fats, seafood, lower-fat dairy products, and plant proteins.

Self-rating diet quality: Surprising results

There appeared to be significant discordance between the researcher-calculated scores and how the study participants rated their diet. The differences are quite large:

• Eighty-five percent of subjects inaccurately assessed their diet quality. Of these, 99 percent overrated the healthfulness of their diet.
• Those who rated their diet as poor appeared the most accurate, with the researcher’s score matching the subject’s rating 97 percent of the time. For the other four rating categories, concordance ranged from one to 18 percent.

So which do you think it is: Do American adults lack an accurate understanding of what constitutes a healthy diet? Or are we more aspirational, perceiving the healthfulness of our diet as we wish it to be?

Please note that the study will be presented later this month and has not yet been peer-reviewed.

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The diseases that a physician sees today are markedly different than in years past. Decades ago, most illnesses were acute (or temporary, such as pneumonia and appendicitis) but today the vast majority are chronic (heart failure and chronic lung disease that stick with you for life).

Chronic disease is transforming health, medical costs and the delivery of care. Diseases such as diabetes, heart failure, emphysema, and cancer are chronic. Once developed, they usually last a lifetime, are difficult to manage and expensive to treat. Chronic illnesses, once rare, are becoming commonplace. They are responsible for the vast majority of health care costs but are, to a large degree, preventable.

Chronic illnesses have two primary antecedents — aging and adverse lifestyles. There has been a remarkable increase in average lifespans and an increasing percentage of those who live a longer time. With aging comes certain impairments, including impaired vision, hearing, mobility (osteoarthritis), bone strength (osteoporosis with fractures), dentition (and with it impaired nutrition) and cognition. Good diet and exercise will limit osteoporosis and joint damage, dental hygiene will limit loss of teeth, avoidance of excessive noise can lessen hearing loss, avoidance of excessive ultraviolet rays from the sun can limit the development of cataracts, and physical and mental exercise along with a good diet can stave off normal cognitive decline.  But as we age, many of these impairments, even with excellent self-care, will develop and progress over time.

But with aging also comes an increased frequency of chronic illnesses – cancer, heart disease, arthritis, diabetes, and Alzheimer’s. These diseases for the most part are mostly related to our lifestyles over a lifetime. Poor diet, lack of exercise, chronic stress, inadequate sleep, tobacco, etc. all conspire over the years to finally manifest as disease. And it is these diseases that most often cause death today.

Author’s Image from Fixing The Primary Care Crisis based on Jones, et al, “The Burden of Disease and the Changing Task of Medicine” in the New England Journal of Medicine. 

As reviewed in the prior article in this series, in 1900, the three most common causes of death in the U.S. were typhoid, tuberculosis and pneumonia – all infectious diseases. Now, the three most common causes of death in the U.S. are cardiovascular, cancer and lung disease – all chronic illnesses, mostly lifestyle-related and all largely preventable.

Not surprisingly, obesity and obesity-related diabetes have also emerged as major predisposing factors to chronic illness and are climbing the list of primary causes of death.

The most important underlying drivers of these chronic illnesses as of 2000, according to a Centers for Disease Control and Prevention (CDC)  report in the Journal of the American Medical Association, are tobacco use, poor dietary habits, lack of exercise and alcohol abuse – all modifiable behaviors. They commented, looking to the future, “These analyses show that smoking remains the leading cause of mortality [in 2000]. However, poor diet and physical inactivity may soon overtake tobacco as the leading cause of death. These findings, along with escalating health care costs and aging population, argue persuasively that the need to establish a more preventive orientation in the US health care and public health systems has become more urgent.”

In the ensuring twenty years, obesity has become epidemic and diabetes is rapidly following. They lead to more heart disease, kidney failure, strokes, and dementia.

The striking reduction of acute, infectious diseases is a testament to the successful collaboration of both science and society in its development and adoption of sanitation, safe water and food, hygiene, antibiotics and immunizations during the last 100 plus years. Safer work environments mean less environmental exposures, trauma and injury.

In addition, the presence of Alzheimer’s and suicide among the common primary causes of death today illustrates the complexity of how aging and mental health are impacting illness and survival. They further signal the reality that mental health has become an entirely new segment of concern in the ever-growing list of chronic diseases in our society. Although present for decades, the appearance of the Covid pandemic amplified the diseases of despair – alcoholism, opioid addiction and overdose deaths.

Older people have more chronic illnesses than younger individuals. But this is not necessarily due to the aging process itself. Yes, older individuals have various impairments, including vision, hearing, mobility and mental capabilities, but the important chronic illnesses such as heart disease, cancer, chronic lung and kidney disease and diabetes are related to long-term effects of lifestyle factors. For example, lung cancer occurs, on average, at age 72, but the steps leading to it began in someone’s teens and twenties when smoking began. Heart disease is more common among the elderly, but the process of creating atherosclerosis begins at a young age with the ingestion of the wrong foods, lack of exercise and good dose of chronic stress over a lifetime. Restated, it takes many years for coronary artery plaque to build up sufficient to cause a heart attack. Just because it occurs after age 65 does not imply that it was related to aging. Rather, it just says that the person has lived long enough for the progressive effects of poor and excessive diet, lack of exercise and related obesity, stress and smoking combined with genetic predispositions to finally have the effect of causing overt disease. Of course, the aging process diminishes the immune system and other body protective mechanisms so that acute and chronic diseases can more easily progress and manifest themselves.

This trend toward prolonged, chronic diseases now poses a new commensurate challenge for both science and society.

The magnitude of the task at hand was illustrated 2007 by the Milken Institute in An Unhealthy America: The Economic Burden of Chronic Disease. They evaluated cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions and mental disorders. The study noted that nearly one half of Americans had one or more chronic illnesses and that “each has been linked to behavioral and/or environmental risk factors that broad-based prevention programs could address.” 

Industry has also recognized that 75 percent of their healthcare costs go to the care of just a few diseases – each chronic and each largely preventable. Commercial insurers, primarily dealing with those under age 65, report that 70-85 percent of paid claims are for chronic illnesses. For Medicare, 85 percent of enrollees have at least one chronic illness, while more than 50 percent of enrollees have three or more chronic illnesses that require them to consume an average of 5 to 7 prescription medications per day.

In 2018 the Milken Institute put out a new comprehensive report entitled “The Costs of Chronic Diseases in the United States.”  Here are the summary conclusions: “Americans’ chronic health problems and diseases not only come at the expense of individuals well-being; they also constitute a massive burden on the U.S. economy. When including the costs of lost economic productivity, the total costs of the varying types of chronic disease in the U.S. is equivalent to almost one-fifth of the American economy. In 2016, the total costs in the U.S. for direct health care treatment for chronic health conditions totaled $1.1 trillion—equivalent to nearly six percent of the nation’s GDP.  The most expensive conditions in terms of direct health care costs are cardiovascular, diabetes, Alzheimer’s, and osteoarthritis.”

Milken emphasizes the importance of obesity on the development of chronic diseases. “Obesity is by far the greatest risk factor contributing to the burden of chronic diseases in the

U.S. The prevalence of obesity in the U.S. population has increased steadily since the 1960s.

In 2016, diseases caused by obesity and being overweight accounted for 47.1 percent of the total

cost of chronic diseases in the U.S. [italics mine]—responsible for $480.7 billion in direct health care costs, plus $1.24 trillion in indirect costs related to lost economic productivity. The total cost of chronic diseases due to obesity in 2016 was $1.72 trillion—equivalent to 9.3 percent of the U.S. GDP that year.”

Our medical care system has developed over centuries around the process of diagnosing and treating acute illnesses such as pneumonia, a gall bladder attack or appendicitis. The internist gives an antibiotic for the pneumonia and the patient gets better. The surgeon cuts out the gall bladder or the appendix and the patient is cured. One patient, one doctor.

But patients with chronic illnesses need a different approach to care. They need long-term comprehensive care, not episodic care. They need a physician with the time and expertise to give continuing attention to all aspects of their care. This physician, preferably a PCP, has the expertise to do most of the care required. But when specialists are needed, the PCP needs to serve as the orchestrator of a multi-disciplinary team with the PCP as quarterback to manage the myriad physician specialists and other health care providers, tests, and procedures to allow for a unified, coordinated care approach. Only when the PCP has the time to give most of the needed care related to chronic diseases and has the time for this type of coordinated approach, will care be maximized yet costs reduced.   

This requires a new paradigm in management, incentives, responsibilities, and compensation for physicians and new responsibilities and incentives for patients as well. The key to this new paradigm is the primary care provider. He or she is well trained and experienced in chronic disease management. But to do this, the number of patients under care by each PCP must be reduced from about 2500-3000 to no more than 500-800. At this level, the provider can have the time needed to listen, prevent, diagnose, treat and think. This will reduce the excessive use of specialists, tests and procedures and the reflex to hand out a prescription when a lifestyle change would be both more appropriate and more effective. And when a specialist is needed, the PCP will have the time to personally call the specialist and explain exactly why he is referring the patient and ask for a prompt appointment. This approach has been proven, as explained in Fixing The Primary Care Crisis , to dramatically improve quality, reduce visits to specialists, ERs and hospitals, reduce the costs of care while improving patient satisfaction, and reducing doctor frustration and burnout.

But dramatically improving care for those with chronic diseases, valuable as that will be, is only part of the equation. Another critical, indeed most important, aspect is prevention which must start with maintaining health and wellness, something America does poorly — at best. A later article in this series will address wellness, health and prevention.

The post Follow The Money in Healthcare – It Will Lead You to Chronic Diseases appeared first on Medika Life.

Now, Amanda leads a global team working to make the world safer from the next epidemic while also urgently responding to COVID-19. Medika Life Editor-in-Chief Gil Bashe spoke with Amanda on the challenges facing public health efforts around the world.

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Gil Bashe:  Amanda, I would like to talk about the core problems that you and Resolve to Save Lives work to address. Let’s talk about why these problems are critical to public health globally, why we have to be much more aware of them, and what’s at stake for the world if we neglect to address the challenges that Resolve to Save Lives has decided to shoulder?

To start, what brought you to global public health? I know you’ve worked with very established organizations like the International Red Cross in the past. Can you talk a little bit about the mindset and transition for a moment?

Amanda McClelland: It’s a good question. Like many people who worked in West Africa during the Ebola epidemic, it raised several issues centered around how to make sure something like that didn’t happen again.

As part of the International Federation of the Red Cross, our work needed to scale across 90 – 100 countries with 17 million volunteers. The work is at the community level, which is so critical. Yet, it was missing a connection point into government systems and structures. We’ve led a lot of advocacy and tried to put communities at the center of our efforts, but it didn’t move beyond the kind of rhetoric of “communities are important.”  There was nowhere for communities to engage inside the existing architecture, whether that be at a domestic or global level.

After 15 years of responding to outbreaks, I’ve been going back to the same countries for different reasons. I worked in Sierra Leone from 2012–to 2013 during a very large cholera outbreak. I was back there in 2014–2015 for Ebola. And despite this, the recovery that we talked about didn’t fit sustainably.

Dr. Thomas Frieden approached me about joining Resolve to Save Lives with a focus on strengthening community systems and targeting preparedness as a full-time position, tapping into my real-world experiences. This was an opportunity to try to make sure that we weren’t going back to the same countries over and over again, and that we were building systems that could detect diseases and respond sustainably.

Bashe:  You and Resolve to Save Lives recently launched an important campaign.  You’ve just taken on non-communicable disease and specifically cardiovascular disease. That is rare when people are frightened about the next pandemic.  Too often we forget to recognize that 70 to 80% of people around the world perish from non-communicable diseases such as heart disease, diabetes, respiratory disease, and mental health illnesses.  Now you are elevating the conversation around cardiovascular disease, why?

McClelland: So often people think it’s a bit strange that we work in two areas, preventing epidemics and cardiovascular illnesses. You’re right, we picked two problems where we think we can save the most lives. COVID-19 has shown us the absolute relationship between infectious diseases and the health of a population.

The impact of COVID’s abilities or mortality from COVID is a stark reminder that a healthy community is critical. Social cohesion and community engagement are at the center of all public health problems. And that comes through in cardiovascular disease and epidemics.

Bashe: I find this to be fascinating because when talking about people most at risk for COVID severity or death, tragically often we talk about people with chronic illnesses, it could be obesity, it could be cardiovascular disease, it could be diabetes. Together these comorbidities are tipping points leading to COVID-related death.

McClelland:  I’m a primary health care nurse by training, so I go one step further and look at those individuals who have chronic conditions—those people who get asked to come back in six months.

What’s the root cause of that? Many of these people, don’t have access to care promptly. They don’t necessarily have good health literacy, good nutrition advice, or access to nutritious food. We know that COVID is disease oriented. But we need to understand that there is a relationship in many countries between low socio-economic indicators, access to care and the increasing amounts of chronic diseases that can easily become acute—like they did during COVID-19—and overwhelm the health system.

We must provide clinical care along with public health interventions for those diseases and start collaborating more effectively. And we think about this as a spectrum, from prevention to early detection and early treatment, all the way through to chronic care and palliative disease. If we don’t start working together, we’re going to lose people through the cracks and that’s where it becomes acute.

Bashe: Great answer. I know you recently had a campaign in Africa and as a global organization, could you talk a little bit about the work you’re doing in Africa?

You know I’m a very big believer that when we look at health, we tend to look at the health of the developed world. There are many problems in ensuring health in the developed world, and among developing nations. They are working to put together infrastructure. I would appreciate your perspective about developing and developed but also why Africa specifically?

McClelland: So, my opinion on this is changing quite a lot and I’ll give you one example. When COVID started, I was working in lower-middle-income developing countries.

For the last 15 years, even in Australia, I worked with indigenous communities that you could say were sometimes worse. I lived in an Aboriginal community, which had massive health challenges and an inexcusable disparity between aboriginal health and the white population in Australia. But when we started the COVID-19 response, Dr. Frieden came to me and said we were going to start responding in the U.S. because New York was getting hit extremely hard.

I said I can’t. I haven’t worked in a high-income country for many years, I don’t understand the American health system. We don’t have anything to add in this context. But we did it. We mobilized a team of 45 people and supported numerous activities at the local level across partner jurisdictions. We ran two different teams—a U.S. team and a global team. We wrote two different sets of guidance—guidance for high-income countries and guidance for low-income countries.

After the first eight weeks, we realized the challenges were similar. High-income countries don’t necessarily have highly resourced public health departments. The public health departments here in the United States are completely underfunded and understaffed. The challenges that we face in Uganda, Liberia and Nigeria were actually to manage because there was a lack of bureaucracy. Teams knew how to collaborate with partners and how to accept outside help. They were able to accelerate through the challenges, trying to supplement like high-income countries.

Across the board, the fundamental challenges remain the same—poorly paid and under-staffed public health systems. Core data infrastructure, the ability to manage data and the ability to make good decisions on that data are commonalities that we all face. We have more in common than we think. There are different challenges in terms of access and cost of care, but not from an epidemic prevention perspective, and also from a chronic disease perspective. Moreover, the under-resourcing of public health is common across many, many developed and developing countries.

Bashe: Could you talk a little bit about what you’ve been doing in Africa, specifically?

McClelland: When we were first starting Resolve to Save Lives, we looked across the globe at where we, as a small but nimble non-governmental organization (NGO), could add the most value. Through an initial assessment, we realized the burden of infectious diseases in Africa, so that was a logical place to start.

When the COVID-19 pandemic began, it became clear that the missions and social measures that developed countries were going to put in place to control COVID would have a significant secondary impact in low-income countries that would make it extremely difficult to maintain.

And so very early on in our work in the pandemic, as early as 2020, we joined up with Africa CDC, WHO Africa, World Economic Forum and several product companies, including IPSOS, as part of the Partnership for Evidence-Based Response to COVID-19 (PERC) to collect data on how public health and social measures would be implemented on the continent.

We wanted to measure both the epidemiology and the secondary impacts such as food insecurity and education disruptions. So, we started our work in Africa with regular large-scale surveys during the pandemic, which we did in four waves across 20 countries. We were able to provide decision-makers with enough data to make balanced decisions. Balancing risk and corporate control against the secondary impacts that those measures caused, strengthened our understanding that the pandemic was not just a health issue. It was also a political and social issue that required data and information from all sides to be able to make informed decisions.

Bashe: And what have been some of the results, I mean that’s the program but how do you see the impact of your efforts?

McClelland: We spoke to the World Bank on global funding and others in terms of where we were seeing change on the ground. We noticed that countries that did very well at the beginning of the pandemic were those that leveraged their public health to enforce social measures. They quickly had political support.

There was a large amount of public trust in most of the countries with the initial government response. But we also saw economic impacts in those countries along with security incidents. While strong trust in the public health system improves outcomes, people’s behavior was also impacted by their ability to meet their daily needs. You can only protect yourself from COVID if you still have enough food and enough fuel, etc.

We have to make decisions based on risk, and we saw the risk perception of the community go up and down with the various waves of the COVID Delta wave. We also see political disruption move up and down with the epidemic curve, along with secondary impacts, as governments turned on and off safety measures. It reinforced the idea that we cannot make these types of decisions just based on cases or deaths.

Every country must find a balance for what works for them in terms of balancing out access to economic opportunities and food and security against what they will accept as a level of COVID. And we’ve seen examples of that. New Zealand versus the United States varies in terms of how they managed COVID and the economic impacts, but also the absolute mortality that caused them.

There are varying thresholds of what is acceptable in different communities. Some communities accepted zero deaths and, in some places, 1,500 deaths a week is still the norm and things are getting back to normal. It is important to understand that pandemic control is a choice that’s driven by politics and communities. And that was a difficult realization for many, that the dependency wasn’t wholly and solely within the health domain, that we were one actor of many trying to influence how this was controlled.

Bashe: When you look at the next six months to a year, what do you hope to achieve?

McClelland: We hope to have this recognized as a once-in-a-generation opportunity to build forward better and to make sure that we recognize the threat that biology still has to us—that we haven’t outsmarted the germs, so to speak.

There are things that you can do to control the risk to make sure that we’re better prepared, to make sure that individuals and systems are more resilient. We have this opportunity in the next six months. We must harness the political will, the financial resources required and the lessons that we’ve learned during COVID to make sure that we build a more protected and healthier world. There is a significant risk that we don’t learn any of these lessons and then we go back into this cycle of panic and neglect. The next six months are so critical for us.

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The next six months may be critical for us.  Keep watching the work of Resolve to Save Lives and their in-the-trenches team to see the progress that they are making to sustain and save lives around the world.

The post Is the Developed World Lightyears Ahead in Public Health? Maybe not! appeared first on Medika Life.

Do it right, and you may discover your blood pressure goes down, your cholesterol improves, and you can experience memory improvements. In addition, you can reduce your risk for diabetes, heart disease, cancer, and more.

Walking can be central to losing weight, dropping blood pressure and cholesterol, and boosting memory, as well as lowering your risk for diabetes, cancer, and heart disease.

I prescribe walking to my patients, a “wonder drug” with health and wellness benefits we often underestimate. Moreover, it’s free, and there are no side effects.

Longevity benefit

Every minute counts. A 2014 University of Utah study discovered this:

For every single minute of brisk walking performed, women dropped their risk of obesity by five percent.

The same institution looked at the power of walking in combating being sedentary. Low-intensity activities (for example, standing) may not be enough to offset the health hazards of sitting for long periods.

The scientists found no benefit in decreasing sitting by two minutes each hour and adding two minutes more of low-intensity activities. However, they noted this:

Trade sitting for light intensity activities for two minutes each hour, and there appears to be a 33 percent lower risk of dying.

Perhaps we focus too much on the benefits of moderate or vigorous activity. Light activity appears associated with a lower chance of premature death. Of course, we need large, randomized, interventional trials to definitively answer whether exchanging sitting for light activities leads to better overall health.

But what about heart health? Fifteen minutes of activity is associated with a 22 percent lower risk of early mortality, according to research presented EuroPRevent 2016 meeting. Walking appeared associated with a 43 percent reduced risk of stroke and heart attack, irrespective of heart rate.

Commenting on his research, Dr. David Hupin, of the University Hospital of Saint-Etienne in Saint-Etienne, France, observes:

Commenting on his research, Dr David Hupin, a physician in the Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne in Saint-Etienne, France observes:

“Age is not an excuse to do no exercise. Regular physical activity has a better overall effect on health than any medical treatment. But less than half of older adults achieve the recommended minimum of 150 minutes moderate-intensity or 75 minutes vigorous-intensity exercise each week.”

For those of you who have not gotten on the physical activity train, the most significant reduction in mortality occurs when we go from being sedentary to becoming moderately active. A study of U.S. veterans is illustrative. Researchers divided subjects into five categories based on their level of fitness.

The least fit healthy adults have an early death risk that is 4.5-times that of the fittest. You may find it surprising that an individual’s fitness level represented a more important predictor of early death than established risk factors such as smoking, high blood pressure, high cholesterol, and diabetes.

What a remarkable reminder that fitness and daily activity have a tremendous influence on the incidence of cardiovascular disease and early mortality.

Such studies underscore that fitness and daily activity levels can strongly influence your chances of suffering from heart disease and improve your overall longevity.

Risks

Fortunately, the risks of cardiac-related complications (such as a heart attack or a severe heart rhythm problem) are extremely low. For adults without heart disease, the risk of a cardiac event is as low as 1 in 400,000 to 800,000 hours of exercise.

For those with known heart disease, the event rate is about one in 62,000 hours. For regular exercisers, the risk is nearly 50 times lower than for a sedentary person.

Even though the risk of exercise is low, please check with your healthcare provider before beginning an exercise program.

Move

If you cannot commit to a half-hour of physical activity on a particular day, try to insert small bits of movement into your routine. Need some ideas? Here you go:3 Small Ways I Move MoreHOW MANY TIMES have you heard me advocate for physical activity? You already know the perils of being sedentary. I try…medium.com

Get started. Increasing evidence shows us that physical activity has a powerful influence on a host of chronic diseases. Just put those shoes on, walk outside, and enjoy your walk.

Thank you for joining me today.

The post Does Walking Extend Life? appeared first on Medika Life.